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Paper short abstract

This paper argues that urban health-seeking is shaped by moral worlds: public care as “deserved" as the durable infrastructure of survival; private care as an aspirational benchmark. Institutional identities are sensed through classed expectations; generics as medicine of the poor.

Paper long abstract

Based on three years of ongoing work in low-income urban neighbourhoods across three Indian states, this paper examines how chronicity is routed through a fractured landscape and how the urban poor inhabit public and private healthcare as distinct moral worlds rather than as a single health system. Policy and popular accounts often explain care-seeking through a cost–efficiency rationale: private providers are preferred for acute illness because they reduce waiting and enable a rapid return to wage labour, while public facilities are used for chronic conditions because they are “affordable” over time. We argue that this account may misrecognise the logics that organise everyday healthcare pathways and the valuations through which people make long-term illness livable. Chronicity is endured and coped with from within distinct moral worlds of healthcare: a need that must be sustained within classed constraints. Public primary care is not simply the cheaper option but is perceived as what one “deserves” as the durable infrastructure of survival. Private care, conversely, functions as an aspirational benchmark characterised by branded pharmaceuticals, attentive treatment, and the promise of efficacy, yet also as a reminder of poverty. Low-cost private clinics, in turn, may be read as proximate to the state, sometimes even mistaken for government facilities, showing institutional identities are sensed through classed expectations. Within this landscape, what policy and research name “fragmentation” is not experienced or perceived by the poor as the breakdown of an integrated plural health system but as a set of discrete service providers without shared pathways.